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5/ Georgia MMIS Presentation November 2010 HP Enterprise Services 835 and 277U Transactions HP Enterprise Services is sending 835 and 277U transactions to the Provider Payee ID. For any Provider that is receiving their 835 and/or 277U transactions through a Trading Partner (i.e. Clearing House, Billing Agent etc), those Providers must: 1. Activate the PIN based on the letter received for the Payee Provider ID. 2. Log into the account and delegate the Trading Partner expected to receive the 835 and/or 277U for that Payee Provider ID. After the weekly cycle is complete, EDI will automatically route the 835 and/or 277U to the TP that was delegated.

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7/ Georgia MMIS Presentation November 2010 HP Enterprise Services Remittance Advices At this point HP Enterprise Services has loaded all of the Remittance Advices (RA) that were provided by the previous Fiscal Agent. HP Enterprise Services does not anticipate getting any additional RAs. Providers can obtain claim status information through the secure web portal Georgia Medicaid Management Information System (GAMMIS) https://www.mmis.georgia.gov. https://www.mmis.georgia.gov NOTE: Please be aware that if the RA image is not present on GAMMIS then it was not received from the previous Fiscal Agent. Recommend for ACS last cycle using a range of dates on panel to pull the RA from web portal. Recommend span of Friday to Monday.

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8/ Georgia MMIS Presentation November 2010 HP Enterprise Services Paper RAs In cooperation with the Department of Community Health (DCH), HP Enterprise Services will no longer provide a paper Provider Remittance Advices (RA). In order to obtain your RA, Providers can log into the secure web portal Georgia Medicaid Management Information System (GAMMIS) https://www.mmis.georgia.gov with your payee identification number and follow the steps below: https://www.mmis.georgia.gov 1. Click on Reports 2. Then click on Financial Reports 3. Click on the drop-down tab and select Remittance Advice 4. Enter the From Date and To Date 5. Click Search

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9/ Georgia MMIS Presentation November 2010 HP Enterprise Services Payments Amounts Where do providers find payments not the RA just payment amounts? This is the payment summary page that used to be on the GHP site but was never a requirement or request to add on the new site until it was mentioned during the BETA session. Post go live recommendation from BETA. IVRS The previous Interactive Voice Response System (IVRS) with Affiliated Computer Services (ACS), required Healthcare providers to enter their Rendering Identification Number to check the status of their weekly payment check. The new HP Enterprise Services IVRS requires Healthcare providers to enter their Payee Identification Number to gain access to their weekly payment check status.

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10/ Georgia MMIS Presentation November 2010 HP Enterprise Services Web Portal Procedure Search In the GHP portal it indicated if a CPT/HCPCS was covered or non- covered. Where is this located on the HP portal? The Procedure Code Search panel allows providers and billing agents to perform searches for procedure code information in relation to Georgia Medicaid. The Categories of Service panel allows providers and billing agents to view detailed restrictions for the procedure code based on the search criteria entered on the procedure code search panel. An exact match must be identified before displaying results on the panel. The detailed information includes restrictions based on a provider's category of service.

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11/ Georgia MMIS Presentation November 2010 HP Enterprise Services Claim Search Should claims that have been billed show up in the web portal? We are unable to see the claims. Navigational Path: Claims - Search (Void, Adjust)

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14/ Georgia MMIS Presentation November 2010 HP Enterprise Services Web Portal_Claims Case Sensitivity for Web claim Submissions Due to case sensitive issues, HP Enterprise Services recently became aware of some Provider web portal claim denials. When entering an online claim, Providers must be aware of how a Members name is entered into the Georgia Medicaid Management Information System (GAMMIS). In order to avoid denial of the claim, capitalization of Members names must appear in the same format as the name on file with HP Enterprise Services. If Providers have any questions about the correct capitalization of a Members name, please visit the eligibility section on GAMMIS https://www.mmis.georgia.gov. HP Enterprise Services is currently working to resolve the issue. https://www.mmis.georgia.gov

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17/ Georgia MMIS Presentation November 2010 HP Enterprise Services DRG Information Providers need to know the calculated DRG to know if a claim has been denied erroneously. Currently the remits are only showing the DRG assigned if the claim is in a paid status. –TBD

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18/ Georgia MMIS Presentation November 2010 HP Enterprise Services Billing Change_Swingbed A Level 1 PASSAR screening must be completed prior to a patient being admitted to Swing Bed. The information will be entered as a prior authorization. DCH will begin editing this information on January 01, 2011.

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21/ Georgia MMIS Presentation November 2010 HP Enterprise Services Member Related Data Member ID Cards –If members have not received their new ID card they can contact either of the numbers to request a reissue. PMP Assignment –If hospital authority is showing as some patients PMP on the web portal, you can request the member to contact HP to select a new PMP.